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Benech N, Bonvalot S, Dufresne A, Gangi A, Le Péchoux C, Lopez-Trabada-Ataz D, Meurgey A, Nicolas N, Orbach D, Penel N, Salas S, Saurin JC, Walter T, Lecomte T, Bouché O. Desmoid tumors located in the abdomen or associated with adenomatous polyposis: French intergroup clinical practice guidelines for diagnosis, treatment, and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, SFR). Dig Liver Dis 2022; 54:737-746. [PMID: 35508462 DOI: 10.1016/j.dld.2022.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Desmoid tumor (DT) of the abdomen is a challenging and rare disease. The level of evidence available to document their treatment is relatively low, however, recent publications of prospective studies have allowed to precise their management. METHODS This document is a summary of the French intergroup guidelines realized by all French medical and surgical societies involved in the management of DT located in the abdomen or associated with adenomatous polyposis. Recommendations are graded in four categories (A, B, C and D), according to the level of evidence found in the literature until January 2021. RESULTS When the diagnosis of DT is suspected a percutaneous biopsy should be performed when possible. A molecular analysis looking for pathogenic mutations of the CTNNB1 and APC genes should be systematically performed. When a somatic pathogenic variant of the APC gene is present, an intestinal polyposis should be searched. Due to a high rate of spontaneous regression, non-complicated DT should first benefit from an active surveillance with MRI within 2 months after diagnosis to assess the dynamic of tumor growth. The treatment decision must be discussed in an expert center, favoring the less toxic treatments which can include broad spectrum tyrosine kinase inhibitor or conventional chemotherapy (methotrexate-vinblastine). Surgery, outside the context of emergency, should only be considered for favorable location in an expert center. CONCLUSION French guidelines for DT management were elaborated to help offering the best personalized therapeutic strategy in daily clinical practice as the DT therapeutic landscape is complexifying. Each individual case must be discussed within a multidisciplinary expert team.
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Affiliation(s)
- Nicolas Benech
- Service d'Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon 69003, France.
| | | | - Armelle Dufresne
- Département d'Oncologie Médicale, Léon Bérard Cancer Center, 28, rue Laennec, Lyon 69373 CEDEX 08, France
| | - Afshin Gangi
- Interventional Radiology, University Hospitals of Strasbourg, Strasbourg University, Strasbourg 67200, France
| | - Cécile Le Péchoux
- Département d'Oncologie Radiothérapie, Gustave- Roussy Cancer Campus, 114, rue Edouard- Vaillant, Villejuif 94800, France
| | - Daniel Lopez-Trabada-Ataz
- Service d'Oncologie Médicale, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, Paris 75012, France
| | - Alexandra Meurgey
- Department of Biopathology, Léon Bérard Cancer Center, 28, rue Laennec, Lyon 69373 CEDEX 08, France
| | - Nayla Nicolas
- Department of Radiology, Institut Curie, Paris, France
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Paris, France
| | - Nicolas Penel
- Centre Oscar Lambret and Lille University, Lille, France
| | - Sébastien Salas
- Oncology Unit, AP-HM, Aix-Marseille University, Marseille, France
| | - Jean-Christophe Saurin
- Service d'Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon 69003, France
| | - Thomas Walter
- Service d'Oncologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon 69003, France
| | - Thierry Lecomte
- Department of Hepatogastroenterology and Digestive Oncology, CHU de Tours, Tours, France
| | - Olivier Bouché
- Department of Digestive Oncology, CHU Reims, Reims, France
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Canouï-Poitrine F, Lièvre A, Dayde F, Lopez-Trabada-Ataz D, Baumgaertner I, Dubreuil O, Brunetti F, Coriat R, Maley K, Pernot S, Tournigand C, Hagege M, Aparicio T, Paillaud E, Bastuji-Garin S. Inclusion of Older Patients with Cancer in Clinical Trials: The SAGE Prospective Multicenter Cohort Survey. Oncologist 2019; 24:e1351-e1359. [PMID: 31324663 DOI: 10.1634/theoncologist.2019-0166] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/21/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The primary objective was to evaluate the rates of older patients with colorectal cancer (CRC) who were eligible for a clinical trial, invited to participate, and, ultimately, included. The secondary objective was to assess the reasons for ineligibility, noninvitation, and noninclusion and factors associated. MATERIALS AND METHODS The Sujets AGés dans les Essais Cliniques (SAGE; Older Subjects in Clinical Trials) multicenter prospective cohort was established in seven centers (10 departments of medical oncology, digestive oncology, and digestive surgery) between 2012 and 2016. All patients with CRC aged 65 or older were studied. The endpoints were clinical trial availability, patient's eligibility, invitation, and enrollment in a trial. RESULTS We included 577 older patients (mean age ± SD: 75.6 ± 7 years; males: 56%; metastasis: 41%). Thirty-seven trials were ongoing (one trial for older patients). Of the 474 patients with at least one available trial for their cancer stage and site, 127 (27%) were eligible; 84 of these 127 (66%) were invited to participate, and 70 of these 84 (83%) were included. In a multivariate analysis, noninvitation was found to be associated with older age (p = .016): adjusted relative risk (95% confidence interval), 0.14 (0.02-0.60) for ≥80 vs. 65-69; 0.54 (0.18-1.04) for 75-79 vs. 65-69; 0.47 (0.17-0.93) for 70-74 vs. 65-69. CONCLUSION Three-quarters of older patients with CRC were ineligible for a clinical trial. One-third of the eligible patients were not invited to participate in a trial, and 17% of invited patients were not included. Few trials are reserved for older patients. Patients aged 80 or older were significantly less likely to be eligible for a trial and invited to participate. Clinical trial identification number: NCT01754636. IMPLICATIONS FOR PRACTICE The results of this study suggest that barriers to participation of older patients in clinical trials are particularly marked at age 80 years or older. Secondly, the results emphasize the need for trials for older patients. Thirdly, there is also a need for more pragmatic "real-world" trials, rather than solely randomized trials performed in idealized settings with strictly selected patients. Large prospective observational cohorts with a precise follow-up of toxicity, functional decline, and quality of life may constitute one way of generating more data on the risk-benefit ratio for cancer treatments in older patients.
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Affiliation(s)
- Florence Canouï-Poitrine
- Clinical Epidemiology and Ageing Unit, Institut Mondor de Recherche Biomédicale, Paris-Est University, Créteil, France
- Public Health Department, Henri-Mondor Hospital, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Astrid Lièvre
- Gastroenterology Department, CHU Pontchaillou, Rennes, France
- Rennes 1 University, Rennes, France
- Digestive Oncology Department, Institut Curie, Saint-Cloud, France
| | - Florent Dayde
- Clinical Epidemiology and Ageing Unit, Institut Mondor de Recherche Biomédicale, Paris-Est University, Créteil, France
- Clinical Research Unit (URC-Mondor), Henri-Mondor Hospital, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Daniel Lopez-Trabada-Ataz
- Medical Oncology Department, Saint-Antoine Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Isabelle Baumgaertner
- Medical Oncology Department, Henri-Mondor Hospital, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Olivier Dubreuil
- Digestive Oncology Department, La Pitié-Salpetrière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Francesco Brunetti
- Digestive Surgery Department, Henri-Mondor Hospital, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Romain Coriat
- Digestive Oncology Department, Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Karin Maley
- Geriatric Department, Georges Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
- Geriatric Department, Les Diaconnesses, Paris, France
| | - Simon Pernot
- Digestive Oncology Department, Georges Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Christophe Tournigand
- Medical Oncology Department, Henri-Mondor Hospital, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Meoin Hagege
- Clinical Epidemiology and Ageing Unit, Institut Mondor de Recherche Biomédicale, Paris-Est University, Créteil, France
| | - Thomas Aparicio
- Digestive Oncology Department, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris, Saint-Denis, France
- Digestive Oncology Department, Saint-Louis Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Elena Paillaud
- Clinical Epidemiology and Ageing Unit, Institut Mondor de Recherche Biomédicale, Paris-Est University, Créteil, France
- Geriatric Department, Georges Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
- Geriatric Department, Henri-Mondor Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Sylvie Bastuji-Garin
- Clinical Epidemiology and Ageing Unit, Institut Mondor de Recherche Biomédicale, Paris-Est University, Créteil, France
- Public Health Department, Henri-Mondor Hospital, Assistance Publique des Hôpitaux de Paris, Créteil, France
- Clinical Research Unit (URC-Mondor), Henri-Mondor Hospital, Assistance Publique des Hôpitaux de Paris, Créteil, France
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Ederhy S, Ancedy Y, Champiat S, Lopez-Trabada-Ataz D, Dulery R, Cohen A. [Cardiac and vascular toxicity of chemotherapies]. Rev Prat 2018; 68:326-329. [PMID: 30869300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cardiac and vascular toxicity of chemotherapies. Cardiovascular complications due to oncologic management are multiple including left ventricular systolic dysfunction, acute myocarditis, hypertension, and QT interval prolongation. Their frequencies are variable depending on the drugs administered. Anthracycline, molecular targeted agents and immune check points inhibitors could lead to left ventricular systolic dysfunction. Anthracyclines could provoke left ventricular systolic dysfunction, which is considered in most of cases as dose-dependent, cumulative and generally irreversible (type 1 toxicity). Targeted molecular agents could lead to left ventricular systolic dysfunction and/or congestive heart failure, which does not appear to be dose dependent, usually reversible at the cessation of treatment and/or the introduction of a cardio-protective treatment (type 2 toxicity).
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Affiliation(s)
- Stéphane Ederhy
- Service de cardiologie, hôpital Saint-Antoine, AP-HP, université Pierre-et-Marie-Curie, Paris-Sorbonne, France
| | - Yann Ancedy
- Service de cardiologie, hôpital Saint-Antoine, AP-HP, université Pierre-et-Marie-Curie, Paris-Sorbonne, France
| | | | - Daniel Lopez-Trabada-Ataz
- Service d'oncologie médicale, hôpital Saint-Antoine, AP-HP, université Pierre-et- Marie-Curie, Paris-Sorbonne, France
| | - Rémy Dulery
- Service d'hématologie clinique, hôpital Saint-Antoine, AP-HP, université Pierre-et-Marie-Curie, Paris-Sorbonne, France
| | - Ariel Cohen
- Service de cardiologie, hôpital Saint-Antoine, AP-HP, université Pierre-et-Marie-Curie, Paris-Sorbonne, France
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